The Medicaid program spends $26.4 billion on mental health care, yet underuse and misuse of recommended treatment and associated adverse and costly clinical events are common. Major gaps persist in our knowledge of how to convert public health insurance into guideline-concordant mental health care, care that is consistent with evidence-based treatment guidelines. The proposed Career Development Award would allow Dr. Burns to supplement her expertise in health policy and economics with the clinical, methodological, and additional economic training necessary to lead clinically and policy-relevant research on the economics of public health insurance design for adults with serious mental illness (SMI). The specific training aims are: 1) to develop knowledge of the natural history and treatment of SMI and the clinical- and systems- level challenges to providing guideline-consistent treatment to very low-income adults with SMI;2) to expand knowledge about the economic incentives created for patients, clinicians, and public mental health authorities by specific features of public health insurance design;3) to acquire methodological expertise in evaluating the impact of public health insurance policies on the receipt of guideline-concordant mental health care using quasi-experimental designs and administrative data. Dr. Burns will be guided by her mentor, Stephen Soumerai, ScD, and co-mentors Jack Burke, MD, MPH, and Haiden Huskamp, PhD. Her career development plan includes coursework and guided study with: Dr. Burke on clinical issues and evidence-based care for SMI treatment;Dr. Soumerai, on the design and analysis of quasi-experimental mental health policy research using claims-based measures of guideline-concordant care;and Dr. Huskamp, on the economics of health insurance and mental health care policy. Dr. Burns will use the knowledge and skills acquired through these career development activities to conduct three studies. The first study examines the extent to which simplification of state Medicaid enrollment and renewal requirements influences Medicaid or private health insurance coverage for adults with SMI and other disabilities. The second evaluates the effects of eliminating annual visit limits for psychotherapy and counseling that is provided outside of a community mental health center on mental health care use and cost including receipt of guideline-concordant care for publicly insured adults with SMI. The third assesses the extent to which changes in the generosity of Medicaid psychiatrist fees are associated with changes in and beneficiary use of, outpatient psychiatrist and non-psychiatrist services, and care process indicators of outpatient mental health care adequacy. The proposed K01 Award will provide Dr. Burns with the training, mentoring, and resources needed to lead independent research in mental health care policy, focusing on the links between the economics of public health insurance, public mental health care delivery, and mental health treatment quality for low-income adults with SMI. PUBLIC HEALTH RELEVANCE: The proposed project is relevant to public health in its focus on state-level policies that have the potential to influence mental health care access and quality for adults with serious mental illness.